Field Management of Facial Injuries in Sports.

This study reviews the epidemiology, diagnostic heuristics, and field management of sports-related facial injuries for sideline physicians.Facial injuries account for 3% to 29% of sports injuries, and sports injuries account for 11.3% to 42.1% of facial fractures. In a previous series, fractures of the nasal bone were the most common in all sports (40%-60.5%); mandibular fractures were common in martial arts (33.3%) and soccer (11.1%), orbital bone fractures were common in basketball (20.0%), ice sports (18.2%), and baseball (15.8%), and fractures of the zygoma occurred frequently in martial arts (13.3%) and soccer (10.0%).Facial lacerations may injure nerves (facial and trigeminal), salivary ducts (parotid or submandibular), and the lacrimal apparatus. Facial fractures are inspected by palpating the bony prominences bilaterally. For simple lacerations, if the player does not have to return to the court, the wound should be cleansed as needed, and surgical adhesives can be applied in the field. However, if return to play is an issue, sutures are recommended rather than surgical adhesives.For nasal injuries involving a gross deformity, immediate closed reduction may not be necessary unless airway competency is compromised. Severe cases of nasal fracture treated immediately by closed reduction should be evaluated by a trained plastic surgeon.In sports, facial injuries are prone to be missed, but their importance should not be neglected. Therefore, sideline physicians should be aware of the relatively high frequency of facial injuries, including facial bone fractures. They should have the knowledge needed to manage these injuries, and must prepare emergency management kits.